22 May 2023
This year marks the twentieth anniversary of the global Campaign to End Fistula and 10 years of commemorating the , instituted to raise awareness of the issue, strengthen partnerships and mobilize support around the globe.
On 14 July 2021, the , by which it recognized that “preventable maternal morbidity is a human rights concern, and preventable deaths and grievous injuries sustained by women and girls during pregnancy and childbirth are not inevitable events, but rather a direct result of discriminatory laws and practices, harmful gender norms and practices, a lack of functioning health systems and services, and a lack of accountability”.
Obstetric fistula is one such morbidity, a devastating childbirth injury that affects impoverished, illiterate and marginalized women and girls,?who often live in remote areas and are denied access to quality healthcare, equality and dignity. Without timely emergency intervention, obstetric fistula, which is caused by prolonged obstructed labor, leaves affected women and girls?with urinary and/or fecal incontinence and severe medical, psychological, social and economic consequences. This was the story of Rose Konga of South Sudan, who became pregnant as a teenager, married at 18 years of age, lost three babies during childbirth, and suffered from obstetric fistula for 21 years before receiving the treatment she needed.
An , and thousands more occur annually. Ninety percent of all cases end in a stillbirth. Obstetric fistula is prevalent in Sub-Saharan Africa, Asia, Latin America and the Caribbean, and the Arab regions.
The prevalence of obstetric fistula stems from underlying gender inequality as well as socioeconomic?and human rights factors. Adolescent pregnancy, child marriage and practices that are harmful to the well-being of women are contributory factors. Women and girls with fistula are stigmatized and isolated, and they are often abandoned by their partners and families. They face intersecting forms of discrimination based on their health, disability, marital status, education and socioeconomic situation, further widening the inequality gap and deepening their poverty. They are among the most left behind.
Obstetric fistula can be prevented when there is access to quality comprehensive sexual and reproductive health services and information. Equally important to ending the condition is the availability and access to treatment when it occurs. However, care does not reach all who need it. The average cost of fistula care ($600) often proves to be a barrier for an already poor woman, an infringement on her right to enjoy the highest attainable standard of physical and mental health, as well as?an indication of the failure of health systems to provide needed care?and of the global community to realize the rights of women and girls.?
The global vision and response???
In 2003, the United Nations Population Fund (UNFPA)—the Organization’s sexual and reproductive health (SRH) agency—and partners launched the , aimed at eliminating obstetric fistula. Today, the campaign is active in 55 countries and focuses on four strategies: prevention, treatment, social reintegration and advocacy, guided by human rights principles of non-discrimination, participation and accountability.
Together with Campaign partners, UNFPA is leading the development of a global roadmap to end obstetric fistula by 2030, mobilizing key actors to help make the dream of ending fistula a reality.
In 2013, the United Nations established the International Day to End Obstetric Fistula, aiming to keep?obstetric fistula high on the global agenda.
In 2018, United Nations Member States adopted , calling for accelerated actions and investments to end fistula within a decade, a vision that aligns with the timeline to achieve the 2030 Agenda for Sustainable Development. Ending fistula is particularly linked to achieving Sustainable Development Goals (SDGs) , , , , , and ;?the commitment to “leave no one behind”; and the promise of the .?
Significant progress has been made, including increased political awareness and action at the global, regional and national levels; enhanced partnerships and coordination mechanisms for fistula, and for maternal and newborn health; increased efforts to strengthen health systems to prevent and treat obstetric fistula; increased efforts to improve data availability; and higher levels of country ownership and commitment. and thousands more by Campaign partners, restoring health, hope and dignity to survivors. Twenty-one countries have national strategies to end fistula with designated government-led task teams to coordinate and monitor efforts.
With only seven years left to achieve the global vision, significant challenges remain. Some 500,000 women and girls are in need of treatment, while thousands of cases still occur every year. Unmet need for holistic treatment is reported in many countries. Available data show that iatrogenic fistulas are on the rise in many countries that already face the burden of obstetric fistula without the capacity to address the challenge.
Factors impeding our goal include stagnant maternal mortality reduction; slow progress of SRH in low- and middle-income countries; a 1.1 million shortfall in essential SRH workers worldwide, including a gap of 900,000 midwives; the challenging impacts of climate change, recent pandemics, humanitarian crisis and conflicts, which also affect access to healthcare and education, and food and water; and increased risk of gender-based violence and gender inequality. Ultimately, women and girls pay the highest price, with many falling into poverty, disease and powerlessness.
Progress cannot be achieved without accountability
We know what works, and we must invest in evidence-based solutions.
UNFPA and Campaign partners updated the to provide evidence-backed strategies and approaches to end fistula by 2030.?
In 2022, the General Assembly adopted , asking ?governments, the international? community, financial institutions, civil society organizations and the private sector to redouble efforts to improve maternal health by making greater investments in universal health coverage, which would, in turn, strengthen?health systems to make maternal healthcare services and obstetric fistula prevention and treatment geographically and financially accessible.
The theme for this year’s observance of the International Day is “20 years on—Progress but not enough! Act now to end fistula by 2030!”. This reflects a call for more commitments to end fistula and to take stock of progress on achieving?them.
We must unite and urgently increase investments and actions to end fistula. We must ensure timely, universal access to trained professionals with midwifery skills at birth, as well as high-quality emergency obstetric and newborn care, family planning services and holistic fistula treatment, including social reintegration and rehabilitation.
At the community level, health education and awareness-raising programs must be made continuously available. Functional quality control of service delivery and monitoring mechanisms, innovation, research and data generation must be funded; new cases and persistent challenges tracked; and good practices documented.
We must empower and meaningfully engage women and girls in all aspects of the programs and eliminate the social determinants that negatively affect their well-being, such as gender-based social and economic inequities, child marriage and early childbearing. The whole community, including men and boys, should be actively engaged as part of the solution!
Finally, we must commit to promoting girls' education and protecting their basic human rights.
At UNFPA, we are doing just that. In our , the Agency commits to ending fistula though our efforts to end preventable maternal mortality, end the unmet need for family planning, and stop gender-based violence and harmful practices.
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